Department of Health, Behavior, and Society, Jimma University, Jimma, Oromia, Ethiopia.
President's Malaria Initiative, United States Agency for International Development, Addis Ababa, Ethiopia.
Malar J. 2021 Aug 28;20(1):355. doi: 10.1186/s12936-021-03887-9.
Insecticide-treated nets (ITNs) access-use has been pivotal monitoring indicator for malaria prevention and control, particularly in resource limited settings. The objective of the study was to compare ITN access-use based on universal household and population indicators and measures adapted to sleeping spaces.
A cross-sectional study was conducted in five districts of Jimma Zone, Ethiopia, March, 2019. 762 HHs were sampled for the survey. Multi-stage followed by simple random sampling used. Monitoring and evaluation reference group's (MERG's) indicators were used for measuring ITN access-use. MERG's indicators are each adapted ITN access-use to sleeping spaces. Household (ownership, saturation and sufficiency) and population access and household members' status of last night sleeping under ITN compared based on the two models. Differences of estimates of ITN access-use based on the two methods reported as magnitude of over/under estimations, at p-value < 0.05.
Based on MERG's approach, the study revealed household (HH) based indicators as such: HH ownership of at least 1 ITN (92.6%), sufficiency of ITN for every two people in HH (50.3%), and saturation of ITN for every 2 people in HHs with any ITN (54.6%). Moreover, population based indicators were: population with ITN access (P3 = 78.6%), people who slept under ITN previous night (63.0%), people who slept under ITN among who accessed it (73.1%), ITN use-gap (26.9%). Equivalent indicators of HH ownership, sufficiency, saturation, and people accessed at where they actually slept, and people slept under ITN among those accessed at where they slept estimated at 71.3%, 49.4%, 69.3%, 66.3%, and 92.1%, respectively. MERG's approach over-estimated ownership, people's access, and behaviour-failures by 21.3%, 12.3%, 19.0%, respectively. Over-estimation occurred for reasons such as many sleeping spaces lack ITN and > 2 people actually slept per sleeping space.
MERG's universal indicators over estimated households and populations ITN access-use as a result of absence of measures capturing access-use values at spaces where people actually slept. Consequently, measures adapted to sleeping contexts revealed potential misdistributions practiced when the existing indicators are in use. Insertion of sleeping spaces into existing approach will be worthwhile and needs to be promoted as it improves curiosity in ITN distribution, produces closer estimates and prevents malaria prevention and control programmes from overlooking access-use challenges.
驱虫蚊帐（ITN）的使用情况一直是疟疾防控的重要监测指标，尤其是在资源有限的环境中。本研究旨在比较基于普遍家庭和人口指标以及适用于睡眠空间的措施的 ITN 使用情况。
2019 年 3 月，在埃塞俄比亚吉马地区的五个区进行了一项横断面研究。对 762 个家庭进行了抽样调查。采用多阶段随机抽样方法。监测和评估参考组（MERG）的指标用于衡量 ITN 的使用情况。MERG 的指标是根据睡眠空间对每个 ITN 的使用情况进行调整。根据这两种模式，比较家庭（拥有、饱和和充足）和人口获得情况以及家庭中前一天晚上使用 ITN 的成员状况。基于两种方法的 ITN 使用情况估计值的差异报告为高估/低估的程度，p 值<0.05。
基于 MERG 的方法，研究揭示了家庭（HH）为基础的指标如下：HH 拥有至少 1 个 ITN（92.6%），HH 中每两个人就有一个 ITN 充足（50.3%），HH 中每两个人就有一个 ITN 饱和（54.6%）。此外，基于人口的指标为：有 ITN 可及的人口（P3=78.6%），前一天晚上睡在 ITN 下的人（63.0%），在前一天晚上有 ITN 可及的人中睡在 ITN 下的人（73.1%），ITN 使用差距（26.9%）。HH 拥有、充足、饱和以及在实际睡觉的地方有 ITN 可及的人和在他们睡觉的地方睡在 ITN 下的人，相当于 HH 拥有、充足、饱和和人口获取的指标，估计分别为 71.3%、49.4%、69.3%、66.3%和 92.1%。MERG 的方法高估了拥有、获取和行为失败的人数，分别为 21.3%、12.3%和 19.0%。高估的原因是许多睡眠空间缺乏 ITN，并且每个睡眠空间实际上有超过 2 人睡觉。
MERG 的通用指标高估了家庭和人群的 ITN 使用情况，因为缺乏在人们实际睡觉的空间中捕捉使用价值的措施。因此，适用于睡眠环境的措施揭示了在使用现有指标时可能存在的分配不当的情况。在现有方法中插入睡眠空间将是值得的，并需要加以推广，因为它提高了对 ITN 分配的兴趣，产生了更接近的估计，并防止疟疾防控计划忽视使用方面的挑战。
